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Clin Med- P > disorders of the penis/testes > Flashcards

disorders of the penis/testes Flashcards

1
Q

what is balanitis?

A

Inflammation of the glans penis

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2
Q

what is balanoposthitis?

A

inflammation of the glans penis WITH Involvement of the foreskin and prepuce

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3
Q

who is most likely to get balanitis/balanoposthitis? why?

A

Uncircumcised men with poor personal hygiene most affected

Maceration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema

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4
Q

symptoms of balanitis (4)

A
  • Penile discharge
  • Pain or difficulty with retraction of foreskin
  • Itching, tenderness of the glans
  • Difficulty urinating or controlling urine stream (very severe cases)
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5
Q

PE of balanitis (4)

A
  • Erythema and edema of glans and/or foreskin
  • Discharge
  • Ulceration and/or plaques
  • Adhesions & phimosis (uncommon)
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6
Q

what four organisms can cause balanitis ?

A

Candida (most commonly associated with diabetes)
Group B and group A beta-hemolytic strep
Gardnerella vaginalis
Trichomonas

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7
Q

txt for balanitis

A

wash!

maybe topical antifungals if you think its candida

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8
Q

what is phimosis? what are the two types?

A

Inability to retract the foreskin

Physiologic & Pathologic

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9
Q

what is physiologic phimosis?

A

congenital

by 3yo, foreskin should retract easily (usually resolves with age)

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10
Q

what is pathological phimosis?

A

previously retractable

older age groups by chronic inflammation or scarring

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11
Q

txt for phimosis

A

topical steroids

Urology referral: circumcision

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12
Q

what is paraphimosis? who gets this? (3 groups)

A

Entrapment of a retracted foreskin behind the coronal sulcus

  • *only occurs in uncircumcised males
  • children whose foreskins have been forcefully retracted or who forget to reduce their foreskin after voiding or bathing
  • Adolescents or adults who present with paraphimosis in the setting of vigorous sexual activity
  • Men with chronic balanoposthitis
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13
Q

how does paraphimosis present? (3)

A

-Red, painful, and swollen glans penis
-Edematous, proximally retracted foreskin
forming a circumferential constricting band
-Penile shaft proximal to the constricting band is typically soft

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14
Q

paraphimosis is dangerous or not?

A

a urologic EMERGENCY!

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15
Q

4 initial txts for paraphimosis

A
  • Ice packs-
  • Glans compression
  • Granulated sugar
  • Hyalouronidase injection
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16
Q

most common initial maneuver to correct paraphimosis?

A

Penile block, lube & attempt at reduction

  • manual compression of the distal glans penis to decrease edema
  • then reduction of the glans back through the proximal constricting band of foreskin
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17
Q

what is the dundee technique for paraphimosis?

A

-Ring/penile block
-Multiple punctures of the edematous foreskin with 26ga needle
-Gentle pressure expresses edema fluid
(Allowing reduction of the prepuce)

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18
Q

what is hypospadias?

A

-Ectopic urethral opening on the ventral aspect of the penis or scrotum (urethra opening not where it should be)
-Anywhere along the median raphe of the perineum
(usually congenital)

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19
Q

what can hypospadias be associated with?

A

chordee (ventral curve of the penis)

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20
Q

when would you do surgical intervention for hypospadias?

A

4-18months

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21
Q

what do you need to be aware of with surgical intervention of hypospadias?

A

genital awareness occurs at about age 18 mo
correction after this can be associated with significant psychological morbidity
abnormal behavior, guilt, and gender identity confusion

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22
Q

do you circumcise someone with hypospadias?

A

NO! foreskin used for corrective surgery

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23
Q

what is epispadias?

A

Failure of complete development of urethra & external genitalia. usually associated with exstrophy (organs forming on the outside of the body)

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24
Q

what does epispadias look like? (3)

A
  1. Phallus is short and broad
    with upward curvature (dorsal chordee)
  2. Glans lies open and flat like a spade
    dorsal component of the foreskin is absent
  3. Urethral meatus is located on the dorsal penile shaft
    anywhere from base to proximal glans
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25
Q

txt of epispadias

A

surgery

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26
Q

what is peyroine’s disease?

A

Abnormal curvature of the penis when erect

-Idiopathic fibrotic plaques on the corpora cavernosa & tunica albuginea

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27
Q

what can peyroine’s disease cause?

A

Can cause painful erections, coital difficulty (erectile dysfunction- from buckling of shaft or lack of rigidity) and dyspareunia

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28
Q

txt for peyroine’s disease

A

In younger men, can resolve spontaneously

if not, Surgery

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29
Q

what is priapism?

A

a persistent,* usually painful, erection of the penis

  • unrelated to sexual stimulation or desire
  • usually > 4hrs
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30
Q

is priapism an emergency?

A

YES may lead to permanent erectile dysfunction and penile necrosis if untreated

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31
Q

what is the most common variant of priapism seen?

A

ischemic- “compartment syndrome of the penis”

- requires emergent txt

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32
Q

what variant of priapism is rare?

A

non-ischemic: often painless, not urgent

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33
Q

what causes priapism?

A

Cavernosal smooth muscle dysfunction most frequently caused by vasoactive medications or nerve dysfunction

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34
Q

what meds can cause priapism? (5)

A
  1. ED agents: sildafenil
  2. Antihypertensives: α-blockers, hydralazine
  3. Antidepressants: fluoxetine, sertraline, citalopram, trazodone
  4. Antipsychotics: phenothiazines, atypicals
  5. Illicit drugs: cocaine, Ecstacy
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35
Q

hematologic causes of priapism (3)

A

Sickle cell disease
Leukemia
Myeloma

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36
Q

CNS causes of priapism (4)

A

CVA
Ischemic/traumatic cord injury
Compressive cord lesion
Nerve root lesion

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37
Q

how does priapism present? (timing and PE)

A

timing: shortly after onset of symptoms because of pain
PE: rigid penile shaft but soft glans
+ “peisis sign,”

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38
Q

how is non-ischemic priapism presentation different?

A

timing: may present after several hours or even days
PE: a partial erection, but the entire penis, including the glans, will be firm

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39
Q

what is the “peisis sign”?

A

partial or complete resolution of the erection during perineal compression

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40
Q

3 part txt of priapism

A
  1. call urology
  2. doppler US
  3. Meds
41
Q

meds for priapism? how does it work? (kinda weeds)

A

PO or SC terbutaline
(ß2-adrenergic agonist, is thought to increase venous outflow from the engorged corpora through relaxation of venous sinusoidal smooth muscle)

42
Q

3 intervention txt options for priapism

A
  1. Corporal aspiration & saline irrigation
  2. Intracavernosal injection
    α-blockers (dilute phenylephrine, epinephrine)
  3. Urologic surgical intervention
    cavernosum-spongiosum shunt
43
Q

what is cryptochordism? is it bilateral or unilateral?

A

Failure of testis/testes to descend. epididymis likely deformed
2/3 unilateral, 1/3 bilateral

44
Q

what is the most common birth defect of male genitalia?

A

cryptochordism

45
Q

4 things that cryptochordism can cause

A

atrophy
increased risk of torsion
testicular Ca
infertility

46
Q

txt for cryptochordism, what age do you txt this issue?

A

Urology referral between 6 mos - 2 years for orchiopexy

47
Q

what is an orchiopexy?

A

surgical distention of an undescended testes (cryptochordism)

48
Q

what is varicocele?

A

Dilatation of the pampiniform plexus
usually left sided b/c the left gonadal vein comes straight from the renal vein. occurs due to nutcracker syndrome (dilation of SMA or abdominal aorta pinching off the left renal vein)

49
Q

varicocele effects __ - ___% of post-pubertal males (weeds)

A

15-20

50
Q

what is important about a right-sided varicocele?

A

they are RARE and should prompt evaluation for an abdominal or pelvic mass – especially if presentation >40 yo

51
Q

how does varicocele present?

A

soft mass, like a “bag of worms” in the scrotal sac, more noticeable when standing

  • dull, aching pain
  • described as “dragging or heaviness”
52
Q

what two complications can varicocele cause?

A
  1. testicular atrophy (secondary to loss of germ cell mass and increased scrotal temp)
  2. infertility (inc. scrotal temP
53
Q

dx of varicocele

A

PE and US (with color)

54
Q

txt for varicocele

A 
varicocelectomy (removal) 
varicocele embolization (catheter to place coils- blood drains back out)
55
Q

what is a hydrocele

A

Collection of peritoneal fluid between parietal & visceral layers of tunica vaginalis

56
Q

how does hydrocele present?

A

Often asymptomatic

despite sometimes considerable scrotal enlargement

57
Q

most hydroceles close spontaneously by age __

A

2

58
Q

Dx of hydrocele

A

transillumination

59
Q

txt for hydrocele

A

hydrocelectomy

60
Q

what is a spermatocele?

A

AKA ‘epididymal cyst’

Retention cyst of a tubule of the rete testis or the head of the epididymis distended with sperm

61
Q

are spermatoceles worrisome?

A

no generally benigns and non-painful

62
Q

what is the most common solid tumor in men 18-40?

A

testicular cancer (but still pretty rare)

63
Q

median age of Dx of testicular cancer?

A

34

64
Q

prognosis of testicular cancer

A

VERY sensitive to chemo: curable even when metastatic

Risk of death: 1/5000= 0.02% chance

65
Q

testicular CA risk factors (kinda weeds)

A
  1. An undescended testicle
  2. Family history of testicular cancer
  3. HIV infection
  4. Carcinoma in situ of the testicle
  5. Previous testicular Ca (3-4%)
  6. Caucasian (4-5x)
  7. Height (tall)
66
Q

testicular cancer PE

A
  • Painless mass or disruption in parenchyma
    Acute pain from rapidly-growing tumors 2° hemorrhage & infarction
    -Firm, non-tender; does NOT transilluminate
67
Q

-Anysolid, firm mass within the testis IS________ _______until proven otherwise

A

testicular CA

68
Q

Dx of testicular cancer

A

US
then Get AFP & β-HCG (tumor markers)
Immediate Urology referral

69
Q

what is epididymitis? what are the types?

A

Inflammation of the epididymis

  • acute, subacute, chronic
  • infectious (e.g. GC/chlamydia) and non-infectious
70
Q

epididymitis is most common in what age groups?

A

20-40yo

71
Q

up to __% of cases of epididymitis involve the testicle

A

40

72
Q

how does epididymitis come about?

A
  • Gradual onset of scrotal pain and swelling: over several days
  • Usually unilateral
  • Irritative voiding symptoms(Dysuria, frequency, and/or urgency)
  • maybe fever and chills (more so for kids)
73
Q

how does epididymitis spread about the testicle?

A

Tenderness and induration first occurs in the epididymal tail
then appears to spread to the body, head, and even the spermatic cord (funiculitis) or the ipsilateral testis

74
Q

is prehn’s sign useful for dx of epididymitis?

A

NO (elevating scrotum and pt feels relief)

75
Q

how can you rule out testicular torsion?

A

positive cremasteric reflex

76
Q

organisms that cause epididymitis ? nonspecific vs STD (weeds)

A

nonspecific: E coli, Pseudomonas, Proteus & Klebsiella species
STD: CHLAMYDIA, N. gonorrhea, T. pallidum, Trichomonas & Gardnerella

77
Q

3 things that may cause epididymitis

A
  1. Scrotal trauma
  2. Idiopathic
  3. Post-vasectomy
78
Q

dx of epididymitis

A

urethral culture swab (before void)

[For GC & chlamydia if patient is in the at-risk age group or if the patient is older than 40 and not monogamous]

79
Q

epididymitis txt

A

1st line: doxycycline or zithromax (if GC/chlamydia is suspected)

  • if enteric organism: levofloxacin
  • NSAIDs and Narcs for pain
80
Q

non-pharm txt of epididymitis

A

-reduce activity, sitz bath, ice packs, scrotal support and elevation

81
Q

what is testicular torsion?

A

Cremaster muscle spasms and twists
Compromising blood flow in testicular artery
Can torse up to 720° (2x around)

82
Q

Extent & duration of torsion influences what?

A

the immediate salvage rate and late testicular atrophy

83
Q

is testicular torsion worrisome?

A

YES! emergency! time is testicle!

84
Q

who gets testicular torsion?

A

men in their 30s, usually with exertion or sleep

85
Q

how does testicular torsion present? (5)

A
  1. Acute onset SEVERE pain, Constant, may radiate into ipsilateral abdomen
  2. Nausea & vomiting in 90%
  3. Scrotal swelling shortly thereafter
  4. elevated teste
  5. abnormal cremasteric reflex
86
Q

Acute scrotal swelling in ANYONE – but especially children – is a _____ until proven otherwise

A

torsion

87
Q

torsion is a ____ Dx

A

clinical.

but US is the modality of choice if you’re unsure

88
Q

testicular torsion prognosis

A
  • <6 hours = testicular salvage
    Can be up to 12 -24 hrs if torsion is <360°
  • 24 + hrs = testicular necrosis
89
Q

what predisposes someone for testicular torsion?

A 
bellclapper deformity
(Failure of normal posterior anchoring of the gubernaculum, epididymis and testis. testis free to swing and rotate within the tunica vaginalis of the scrotum)
90
Q

what can testicular torsion progress to?

A

In time, a reactive hydrocele, scrotal wall erythema, and ecchymosis can occur

91
Q

testicular torsion, if urology isnt available, what can you do?

A

attempt de-torsion: rotate tested OUTWARD like the opening of a book

92
Q

how do you know the de-torsion was successful?

A
  1. Relief of pain!!!
  2. lower position of testis in scrotum
  3. normal arterial pulsations on Doppler ultrasound
93
Q

although most testes torse medially, ___ torse laterally

A

1/3

94
Q

what is appendiceal torsion?

A

small vestigal structures on testes that torse.

Pedunculated (hanging on a “stalk) which predisposes to twisting/torsion

95
Q

what is the Leading cause of acute scrotal pathology in childhood?

A

appendiceal torsion

80% of cases are between age 8-14

96
Q

appendiceal torsion PE?

A

gradual onset of pain- mild to severe

  • maybe reactive hydrocele
  • localized
  • “blue dot” sign
97
Q

what is the blue dot sign?

A

in appendiceal torsion:
Infarction/necrosis seen through thin scrotal skin
‘Classic’ finding (present only in ~21%)

98
Q

how to distinguish appendiceal torsion vs testicular torsion?

A

US for appendiceal will show normal bloodflow

99
Q

appendiceal torsion txt (4)

A

Conservative tx

  1. Rest, ice, NSAIDs/analgesics
  2. Infarcted tissue is resorbed
  3. Recovery is usually slow (weeks – months)
  4. surgery not necessary BUT its safe and fast ( local anesthesia)

Clin Med- P (124 decks)

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